Provider Demographics
NPI:1386935567
Name:IVERSEN, PETER B JR (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:B
Last Name:IVERSEN
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3453 39TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3415
Mailing Address - Country:US
Mailing Address - Phone:206-403-8651
Mailing Address - Fax:
Practice Address - Street 1:4700 42ND AVE SW STE 555
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4583
Practice Address - Country:US
Practice Address - Phone:206-935-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE602832651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice